Kathleen Madden, FNP, MSN, AOCNP, APHN, nurse practitioner, Melanoma Program, NYU Langone Health's Perlmutter Cancer Center, discusses how to judiciously use steroids to manage adverse events (AEs) in patients with melanoma who are receiving immunotherapy.

Steroid therapy sometimes as a “necessary evil,” according to Madden, because the adverse events (AEs) associated with immunotherapy can be inflammatory in nature. When patients are unresponsive to supportive measures to address the AEs, steroids are conservatively used, explains Madden.

When patients begin immunotherapy, they are told to inform providers when their AEs start because they cannot make it through treatment without supportive care. In the beginning, the AEs will have a slow and steady onset, but the pace can pick up quickly—especially if patients are receiving combination therapy, says Madden.

Dosing will depend on the severity of the toxicity, and that is graded by the information patients provide, says Madden. Common Terminology Criteria guidelines are also used. Usually, patients are tapered off drugs at a steady pace, depending on the level of toxicity, according to Madden. Often, antacid therapy is important to prevent acid reflux and secondary tissues with ulcers. For patients who are on high doses of immunotherapy for longer periods of time, adjunctive therapies may be considered to prevent secondary infections, concludes Madden.

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Kathleen Madden, FNP, MSN, AOCNP, APHN, discusses how to judiciously use steroids to manage adverse events in patients with melanoma who are receiving immunotherapy.

Using Steroids to Manage Immunotherapy-Associated AEs in Melanoma

Kathleen Madden, FNP, MSN, AOCNP, APHN, nurse practitioner, Melanoma Program, NYU Langone Health's Perlmutter Cancer Center, discusses the nuances of immunotherapy related adverse events (AEs) in melanoma.

It’s important to be familiar with the agents that patients are receiving as each drug has a nuanced toxicity profile, says Madden. For example, PD-1 inhibitors can have more pulmonary and renal toxicities, but patients also tend to stay on these agents for a little bit longer. CTLA-4 inhibitors, especially in the standard dose or in combination, will be administered in a briefer period of time. Gastrointestinal toxicities tend to be more nuanced with CTLA-4 inhibitors; however, combinations can exacerbate those types of AEs.

When patients come to the clinic, providers should discuss the organ systems that may be impacted by treatment. In doing so, providers can collect information and patients can gain valuable insight into the types of AEs to be aware of, concludes Madden. 

Kathleen Madden, FNP, MSN, AOCNP, APHN, discusses the nuances of immunotherapy related adverse events in melanoma.

Kathleen Madden, FNP, MSN, AOCNP, APHN

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Using Steroids to Manage Immunotherapy-Associated AEs in Melanoma

Nuances of Immunotherapy-Related AEs in Melanoma